Gallet Justine, Laurent François, Paris Christophe, Clin Bénédicte, Gislard Antoine, Thaon Isabelle, Chammings Soizick, Gramond Celine, Ogier Guy, Ferretti Gilbert, Andujar Pascal, Brochard Patrick, Delva Fleur, Pairon Jean-Claude, Lacourt Aude
Bordeaux Population Health Research Center, Equipe EPICENE, Université de Bordeaux, INSERM U1219, F-33000 Bordeaux, France.
Université de Bordeaux, Faculté de Médecine, F-33000 Bordeaux, France.
Occup Environ Med. 2022 Aug 3. doi: 10.1136/oemed-2022-108337.
Occupational asbestos exposure is associated with pleural plaques (PP), a benign disease often seen as a marker of past exposure to asbestos and lung cancer. The association between these two diseases has not been formally proved, the aim of this study was to evaluate this association in the asbestos-related disease cohort (ARDCO) cohort.
ARDCO is a French multicentric cohort including workers formerly occupationally exposed to asbestos from 2003 to 2005. CT scan was performed to diagnose PP with double reading and lung cancer (incidence and mortality) was followed through health insurance data and death certificates. Cox models were used to estimate the association between PP and lung cancer adjusting for occupational asbestos exposure (represented by cumulative exposure index, time since first exposure and time since last exposure) and smoking status.
A total of 176 cases (of 5050 subjects) and 88 deaths (of 4938 subjects) of lung cancer were recorded. Smoking status was identified as an effect modifier. Lung cancer incidence and mortality were significantly associated with PP only in non-smokers, respectively, HR=3.13 (95% CI 1.04 to 9.35) and HR=16.83 (95% CI 1.87 to 151.24) after adjustment for age, occupational asbestos exposure and smoking status.
ARDCO study was the first to study this association considering equal asbestos exposure, and more specifically, our study is the first to test smoking as an effect modifier, so comparison with scientific literature is difficult. Our results seem to consolidate the hypothesis that PP may be an independent risk factor for lung cancer but they must be interpreted with caution.
职业性石棉暴露与胸膜斑（PP）有关，胸膜斑是一种良性疾病，常被视为过去接触石棉和肺癌的标志。这两种疾病之间的关联尚未得到正式证实，本研究的目的是在石棉相关疾病队列（ARDCO）中评估这种关联。
ARDCO是一个法国多中心队列，包括2003年至2005年曾职业性接触石棉的工人。通过双重阅片进行CT扫描以诊断胸膜斑，并通过健康保险数据和死亡证明追踪肺癌（发病率和死亡率）。使用Cox模型估计胸膜斑与肺癌之间的关联，并对职业性石棉暴露（以累积暴露指数、首次暴露时间和末次暴露时间表示）和吸烟状况进行校正。
共记录了5050名受试者中的176例肺癌病例和4938名受试者中的88例肺癌死亡。吸烟状况被确定为效应修饰因素。仅在不吸烟者中，肺癌发病率和死亡率与胸膜斑显著相关，在对年龄、职业性石棉暴露和吸烟状况进行校正后，风险比（HR）分别为3.13（95%置信区间1.04至9.35）和16.83（95%置信区间1.87至151.24）。
ARDCO研究是首个在考虑等量石棉暴露的情况下研究这种关联的研究，更具体地说，我们的研究是首个将吸烟作为效应修饰因素进行检验的研究，因此难以与科学文献进行比较。我们的结果似乎支持了胸膜斑可能是肺癌独立危险因素的假说，但对其解释必须谨慎。
